WOFAPS 2025 8th World Congress of Pediatric Surgery

ABIRAMI KRITHIGA JAYAKUMAR

RAINBOW CHILDRENS HOSPITAL, CHENNAI, INDIA

Introduction: Acute small bowel obstruction (SBO) is a common pediatric surgical emergency, often managed operatively when conservative treatment fails. Hyperosmolar water-soluble contrast has emerged as both a diagnostic and therapeutic adjunct in the non-operative management (NOM) of small bowel obstruction (SBO) in children.

Case presentation: Six children aged between 7 months and 12 years presented with abdominal distension and vomiting between postoperative days 4 and 7. The cohort included three children post-appendectomy (one each for acute appendicitis, chronic appendicitis, and perforated appendicitis), two children following Ladd’s procedure for malrotation, and one child post-laparotomy for peritonitis.

Each child received an oral dose of Gastrograffin, and serial abdominal radiographs were obtained at 30 minutes, 1 hour, 3 hours, 6 hours, and 12 hours. Five out of six children experienced a single episode of vomiting after contrast administration. In four patients, contrast hold-up was noted in the small intestine up to 6 hours; however, contrast was completely cleared in all six cases by the 12-hour film.

Conclusion

The use of hyperosmolar contrast such as Gastrograffin demonstrated both diagnostic clarity and therapeutic benefit in the non-operative management of postoperative small bowel obstruction in children. In our case series, timely administration of contrast facilitated resolution of symptoms and obviated the need for reoperation in all six children. Hyperosmolar contrast agents thus represent a safe, effective, and minimally invasive strategy, potentially a game changer, in the early management of pediatric SBO.